by Jessica Pasley
In a large, prospective study of children with COVID-19 infection at Monroe Carell Jr. Children’s Hospital at Vanderbilt, researchers found that most children experienced brief and mild illness with a small minority requiring hospitalization.
During the onset of the pandemic, medical teams were not sure how the infection would impact children. As the number of children diagnosed with the virus grew, the questions about the severity of the disease and length of the illness became a concern.
“There was a lot of information about the impact on adults — the severity of the disease and high mortality rates worldwide,” said Ritu Banerjee, MD, associate professor of Pediatrics and Pediatric Infectious Diseases at Children’s Hospital. “But what about the pediatric population? If children did have the disease, who would end up with severe illness, and if there were mild cases, how long would they be sick?
“Our study looked at all children within our health system who tested positive for COVID between March and September 2020. Most studies were looking at hospitalized children only, just the sickest of patients.”
The study, “The first 1,000 symptomatic pediatric SARS CoV-2 infections in an integrated health care system: a prospective cohort study,” published in BMC Pediatrics, also took the study to another level.
“What makes our study novel — we did systematic phone follow-up with all of these children to see how they did,” said Banerjee, one of the study’s authors. “We also looked for characteristics that were associated with severe disease and hospitalization.”
Study findings showed:
- 96% of infected children remained outpatients with very short-lived symptoms.
- By five days after diagnosis, half of the children had complete system resolution.
- By one month, 94% were completely better.
- Hospitalizations were more likely to occur among children with co-existing medical conditions, being Black or Hispanic or presenting with shortness of breath or vomiting.
The findings are consistent with other studies.
“We were able to identify children at highest risk for severe COVID, which will allow us to target those children for preventive therapies like vaccinations and monoclonal antibodies or antivirals that may be developed in the future,” said Banerjee.
“And if a child who is not eligible to be vaccinated were to become infected, then we could target them for treatment to reduce the severity of the illness.”
This component of the study was possible with the assistance of Dan Byrne, MS, director of Artificial Intelligence Research for the Advanced Vanderbilt Artificial Intelligence Laboratory.
Byrne’s team of biostatisticians, including Henry Domenico, MS, and Ryan Moore, MS, performed the statistical analysis and built the predictive model to compute the probability that if a child was positive for COVID-19 he or she would need to be hospitalized.
“This is a great example of Vanderbilt using predictive models to not only publish a paper but to also improve patient outcomes and hospital operations,” said Byrne.
The study was done prior to the most recent surge of the delta variant that saw a marked increase in pediatric infections, but not necessarily more severe disease, Banerjee pointed out.
The takeaway according to Banerjee:
“Parents, caregivers and medical professionals all need to be aware of the risk factors for hospitalization in children with COVID. If they are caring for children in high-risk groups, they need to get vaccinated, and people within the household need to be vaccinated to prevent infection in these children. And providers need to be able to identify patients at high risk for hospitalization to provide closer follow-up after COVID infection, if needed.”
The lead author of the paper was Leigh Howard, MD, assistant professor, Pediatric Infectious Disease. Co-authors included Kathryn Garguilo, MSN, RN, Jessica Gillon, PharmD, BCPS, Kerry LeBlanc, MSN, CPNP-PC, Adam Seegmiller, MD, PhD, Johnathan Schmitz, MD, PhD, and Natasha Halasa, MD.